What is MDR ?

The emergence of multi-drug resistant (MDR) strains of Mycobacteria has had a large effect on the increase  of incuuuurable tuberculosis cases.  Drug resistance is  magnified by patients who fail to take the chemotherapeutic drugs for the prescribed period.  This allows the infecting Mycobacteria to survive, mutate and become drug resistant.  Mycobacterial drug resistance was first recognised in 1946 after the introduction of streptomycin for the treatment of tuberculosis.  When given alone , the drug would initially reduce the  numbers of bacilli in the patient, resulting in an improvement of clinical symptoms.  However, the bacilli would then start to grow , unaffected by the drug.  As a result of this  phenomenon , streptomycin is now only given as a component of a combination of anti-tuberculosis drugs.

Six years ago, Arthur Medcalf led a fast-paced life style.  A Cape Town  sales representative for a plastics factory, the 48 year-old father of four travelled widely on business but still managed to find time for his family and the sailing regattas he organized for a sea scout troop.  When he developed a persistent cough in February 1989, his doctor prescribed antibiotics and warned him to slow down.  By August Medcalf, was so exhausted that he could hardly drag himself to work.  Tests revealed tuberculosis, probably contracted from workers at his factory in Elsie's River, an area rife with Tb.  He was put on a regimen of five tablets a day containing the normal combination of drugs used to fight Tb.  He should have started to feel better within two weeks, but if anything he felt more weary.  Three months later, when sputum tests showed he was still infectious, an x-ray uncovered a fist-size  cavity in his left lung, caused by a multi drug-resistant (MDR) strain of Tb.
Admitted to Groote Schuur Hospital's Respiratory Clinic, Medcalf was put on a number of trial drugs.  When worried doctors had tried every locally available combination without success, he was placed in an isolation ward.
By Christmas, when his weight had dropped to 47 kiliograms, Dr Paul Wilcox, a senior specialist at the Respiratory Clinic, obtained permission from the Medicines Control Council to try a new drug, Tarvid, approved for use in the US but not then available in South Africa.  He wanted to combine it with Amikacin, a restricted drug, he told Metcalf, but warned the treatment   would damaged the nerve ends of the inner ear and could lead to deafness.  Medcalf,  who was now so weak he could barely walk,  didn't hesitate.  " Go ahead, " he said.  " I want one last shot at life".
Dr Wilcox hardly dared believe the first negative sputum test, but four more confirmed it.  After eight harrowing months, the disease had finally been checked.
At last, Medcalf returned home, with 70 per cent of his hearing and 25 per cent of his lungs  destroyed.  For the next 18 months, he swallowed 32 pills a day to avoid the relapse suffered by one in five  recovered MDR-tb patients, then was eventually pronounced cured.  " Lack of hearing means I can no longer work in sales and I tire too easily to run a scout troop," he says. " But I'm alive ! ".

Arthur Medcalf is one of the lucky ones.  Half of the 1000 or so South Africans who contract MDR-tb every year die. These new forms of Tb can be as deadly as Aids and are much more infectious.

When the symptoms ----- weight loss,   coughing, chest pain, night sweats, tiredness ---- become persistent , the disease is already far advanced, and ten to 15, of the sufferer's contaacts have probably become infected.  Untreated or incurable patients die a slow,  ugly death over about two years, coughing up more and more of their lungs and infecting family, friends and colleagues.

Over 50 million people are infected with MDR tb, 2500 of them are in South Africa.  Alreadly frightening, these numbers  could  mushroom if the disease cannot be controlled.